Provider Demographics
NPI:1861165003
Name:PREMIER HEALTH & WELLNESS CENTER OF CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:PREMIER HEALTH & WELLNESS CENTER OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NETRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-297-2737
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:CLARCONA
Mailing Address - State:FL
Mailing Address - Zip Code:32710-0705
Mailing Address - Country:US
Mailing Address - Phone:321-297-2737
Mailing Address - Fax:877-797-7978
Practice Address - Street 1:415 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4703
Practice Address - Country:US
Practice Address - Phone:321-297-2737
Practice Address - Fax:877-797-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory